THE MISSISSIPPI LEGISLATURE

The Joint Committee on

Performance Evaluation and Expenditure Review

Report # 514

An Evaluation of Mississippi’s Medicolegal Death Investigation Process

Executive Summary

Introduction

Medicolegal death investigations (i. e., investigations that combine gathering and interpreting information about the circumstances and causes of a particular death) serve numerous societal interests. In the face of recent concerns about the quality of death investigations in Mississippi, the PEER Committee evaluated the state’s medicolegal death investigation process, focusing on activities of the State Medical Examiner’s Office.

Mississippi’s medicolegal death investigation system has evolved from a purely local system to a mixed system in which local coroners and a central State Medical Examiner’s office share authority. State law makes the State Medical Examiner the state’s expert in forensic death investigations. Under the Mississippi Medical Examiner Act (MISS. CODE ANN. § 41-61-55 [1972]), the State Medical Examiner must be a physician board-certified in forensic pathology. The State Medical Examiner is to have authority over physician county medical examiners and non-physician county medical examiner investigators and responsibility for medicolegal death investigation training and rule promulgation. Duties of the State Medical Examiner fall into the following primary categories:

special statutory duties regarding deaths in state correctional institutions and infant deaths from Sudden Infant Death Syndrome (SIDS).

Conclusions

Has the State Medical Examiner’s Office fulfilled its statutorily prescribed duties with respect to death investigation?

Because of the long-time vacancy in the position of State Medical Examiner, an insufficient number of staff, and underfunding of the office, the State Medical Examiner’s Office has not been able to ensure that all of its statutory responsibilities have been addressed.

State law makes clear that the Legislature created the State Medical Examiner’s Office for the purpose of ensuring that deaths are investigated throughout the state competently and uniformly. PEER concludes that the office has not always been able to fulfill responsibilities placed on it by the comprehensive legislation adopted for death investigations, as evidenced by the following:

Since 1995, designated pathologists have been performing all autopsies referred to a medical examiner. No state-level oversight of these designated pathologists has been exercised since 1991.

The office’s staff currently does not have the medical expertise to review the reports filed by local medical examiners.

The office has not effectively fulfilled some of its recordkeeping duties—specifically, reconciliation of local medical examiners’ death reports with death certificates from the Department of Health—because some county medical examiners/investigators do not file necessary documents with the office.

Because the State Medical Examiner’s position is vacant, the office has not technically complied with the statutory requirement for the State Medical Examiner to perform autopsies when deaths occur in the correctional system.

Weaknesses in the State Medical Examiner’s program may be attributed primarily to vacancies in the State Medical Examiner’s position, other staffing issues, and historical underfunding of the office.

While the role of State Medical Examiner is one of great importance, the position has been filled only sporadically over the past twenty-three years. The instability in this position has given rise to an environment wherein important regulatory and managerial duties go unattended because there is no person with the statutorily require background to give leadership and direction.

The State Medical Examiner’s Office currently must rely on the Mississippi Crime Laboratory for oversight and staff support. As of June 2008, three positions—two medical examiner assistants and one support technician—in the State Medical Examiner’s Office were filled, and the incumbent in one of these positions had been on military leave for approximately two years. Currently, two crime lab employees perform support functions for the State Medical Examiner’s Office.

In addition to a lack of leadership, the State Medical Examiner’s Office has not received funding adequate for the purpose of carrying out the duties and responsibilities set out in statute. Only in the current fiscal year, FY 2009, has there been sufficient funding on hand to hire a State Medical Examiner and other medical doctors who could perform forensic analysis and provide technical and professional support to the death investigation process.

What are the policy implications of the weaknesses of the State Medical Examiner’s program?

The lack of a State Medical Examiner or adequate staffing impairs the state’s ability to ensure that issues surrounding deaths affecting the public interest are resolved competently.

Because of the lack of a State Medical Examiner for the past thirteen years, the office has been unable to regulate effectively. In recent years, the processes of death investigation in Mississippi have come under close and often critical scrutiny, perhaps most notably in the criminal case of Edmonds v. State, 955 So. 2d 787 (Miss, 2007). In Edmonds, the court reversed a criminal conviction of a defendant convicted of capital murder. One justice concurring in the result was sharply critical of the testimony of a designated pathologist who performs autopsies in Mississippi cases when county medical examiners have concluded that an autopsy is necessary.

While PEER is in no position to opine as to the professional competence of persons performing functions in the medical field, one can note that large numbers of autopsies are being performed by a person who is not board-certified in forensic pathology and that the one position that can regulate or oversee the activities of persons performing forensic work in the state has been vacant since 1995.

Because the Office of the State Medical Examiner has historically been underfunded, the office has been unable to fulfill part of its service role. Inadequate staffing in the State Medical Examiner’s Office has caused local death investigators to depend on designated pathologists. The inability of the office to perform the most rudimentary levels of oversight such as records review and reconciliation and meeting with other professionals on updating and overseeing the work of designated pathologists may be attributed to an inadequate number of other staff in addition to the lack of a State Medical Examiner.

Should the Legislature change state laws dealing with death investigation?

Several sections of the MISSISSIPPI CODE addressing the authority of the State Medical Examiner are unclear as to the office’s authority in critical areas of death investigation.

Some provisions of current law are ambiguous as to where authority lies for making certain critical decisions regarding death investigations and other provisions regarding the promulgation of rules and regulations for death investigations appear to be contradictory. Also, statutes governing death investigation split authority for conducting death investigations between local and state officials.

Policy Options

Option One: Retain the Current System, Make Technical Corrections to the Law, and Increase Funding

Under this option, the state would commit itself to funding a State Medical Examiner’s Office that is capable of providing not only regulation of death investigation, but all services needed to assist local death investigators in the furtherance of their duties. Such a system would provide the office with sufficient numbers of pathologists to perform most autopsies needed to complete death investigations. These pathologists would be regularly reviewed for their work quality.

Under this option, the office would clearly be responsible for regulating the performance of death investigation and would routinely review all filings of local death investigators to insure that their work is being performed professionally. State law would need to clarify the conflicts and ambiguities in law.

Under state law that became effective July 1, 2008 (H.B. 525, Regular Session 2008), the cost of a forensic autopsy will increase from $550 to $1,000 per autopsy. Assuming that the State Medical Examiner’s Office is able to perform at least 1,000 autopsies per year, this would generate for the office $1 million in fee-based revenue to support office operations, thereby making the office closer to self-sufficiency.

Option Two: Establish a Pure State Investigation System

Under a pure state investigation system, the state would bear the costs of investigating all deaths affecting the public interest. To facilitate such a system the following would have to occur:

abolition of the local office of coroner; and,

creation and funding of a statewide death investigation system.

Abolition of the Coroner’s Office: While the statutes refer to the offices of county medical examiner and county medical examiner investigator, the office of coroner is a constitutional office under Section 135 of the MISSISSIPPI CONSTITUTION. While this section provides that the duties of the office may be combined with that of another office, it does not authorize the abolition of any office. Consequently, the office of coroner would have to be abolished through a constitutional amendment.

Funding of a State System: Some states combine the investigative functions that are split between state and local authorities in Mississippi into a single central state agency. In such states, the responsibility for investigating deaths, collecting evidence, as well as performing and overseeing autopsies, is in the hands of the state agency. Such arrangements give the state complete control over the management, selection, and training of staff that work in medicolegal death investigations, unlike our mixed system wherein the local medical examiners control the decision to select local staff. Such an approach insures consistency in the quality of personnel selected.

Centralized models have their drawbacks also. The loss of locally selected medical investigative staff could destroy relations that have been forged over time between local law enforcement agencies. Such impairments could frustrate death investigations. Additionally, centralized systems add costs to the state that under mixed systems are borne by local government.

In the state of Maryland, for example, not only does the state perform autopsies, it also is responsible for field investigation of deaths. Maryland has on staff fifteen investigators who carry out the functions similar to those of Mississippi’s county medical examiners and county medical examiner investigators. Salary expenses for these staff are approximately $500,000 per year. While Maryland does perform about 4,500 autopsies per year, about 2.25 times Mississippi’s workload, the state is geographically smaller. (Maryland’s total area is 12,407 square miles versus Mississippi’s total area of 48,430 square miles.) Thus Maryland’s death investigators cover a much smaller area with corresponding reduced travel times than would Mississippi’s investigators.

If Mississippi were to utilize such a system, its costs would most likely be greater than 44% of Maryland’s costs. Additionally, a larger central staff would also require additional support staff to assist in the management of a fully centralized death investigation system.

Option Three: Eliminate the State Medical Examiner’s Office and Revert to a Local System

Under this option, Mississippi would revert to its pre-1974 approach to investigating deaths. The coroner system would operate without the benefit of a centralized support system to ensure effective operations. Such a system would be likely to cost local governments no more than the current system: a death investigation system in which there is no State Medical Examiner, wherein counties bear the burden of paying for death investigations and autopsies.

Obviously such a system would not cost the state as much as is currently expended on the limited operations of the State Medical Examiner’s office. While financially this option would generate savings to the state, non-financial costs related to death investigation would be similar to those discussed earlier in this report. Criticism and concern regarding the quality of the state’s forensic investigations would be likely to continue without support from trained oversight personnel.